New Student Enrollment

New Student Information

Select the Submit Application tab after you have filled in all information including students, primary and secondary family, and emergency/contacts. Use the tab buttons to select the pages to fill in the information. * Required fields are bold.

Student 1

*Last Name*First NameMiddle NamePreferred Name*Date of Birth (mm/dd/yyyy)*Gender*Program Choice*Extended HourChurch AffiliationPrimary E-MailSecondary E-MailSibling names and ages*Student TShirt SizeAffidavit Exemption Received

Student 2

Student 3

Student 4

Student 5

Primary Family Information

*Address Line 1Address Line 2*City*State*ZIP CodeHome Phone

Parent 1 Information

*Last Name*First NameMobile PhoneHome E-MailMarital StatusCompany NameBusiness PhoneIs Allowed to Pickup

Parent 2 Information

*Last Name*First NameMobile PhoneHome E-MailMarital StatusCompany NameBusiness PhoneIs Allowed to Pickup

Secondary Family Information

*Address Line 1Address Line 2*City*State*ZIP CodeHome Phone

Parent 3 Information

*Last Name*First NameMobile PhoneHome E-MailMarital StatusCompany NameBusiness PhoneIs Allowed to Pickup

Parent 4 Information

*Last Name*First NameMobile PhoneHome E-MailMarital StatusCompany NameBusiness PhoneIs Allowed to Pickup

Contact Information (Other than parents)

Contact 1

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseCell PhonePickup TagPickup Notes

Contact 2

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseCell PhonePickup TagPickup Notes

Contact 3

*Last Name*First NameRelationIs Emergency ContactHome PhoneIs Allowed to PickupBusiness PhonePickup LicenseCell PhonePickup TagPickup Notes

Medical Contacts

PhysicianPhysician Phone NumberDentistDentist Phone NumberHospitalHospital Phone NumberInsuranceInsurance Phone NumberPolicy Number

Finished

Confirmation E-Mail address:

Please press the save button to submit the new student application.

Date of Last Upload: Wednesday, August 23, 2023 Student Enrollment Form

Student 1

Primary Family Information

Parent 1 Information

Parent 2 Information

Secondary Family Information

Parent 3 Information

Parent 4 Information

Contact Information (Other than parents)

Contact 1

Medical Contacts